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A new study has shown that the preventive effect of the breast cancer drug, tamoxifen, remains virtually constant for at least 20 years, with breast cancer rates reduced by around 30 percent. Median 16-year follow-up results from the IBIS-I (International Breast Cancer Intervention-I) trial show a 29% lower risk for developing breast cancer among women who had been randomly assigned to five years of tamoxifen than for women assigned to five years of placebo.
“Tamoxifen is a well-established and effective treatment for certain breast cancers, but we now have evidence of its very long-term preventive benefits…" said Professor Jack Cuzick, IBIS-I lead author and Head of the Centre for Cancer Prevention at Queen Mary University of London. Professor Cuzick underscored the “strong and unabated” 20-year preventive effect of breast cancer resulting in a reduction in breast cancer rates of around a third. “We hope these results will stimulate more women, particularly younger women, to consider treatment options for breast cancer prevention if they have a family history of the disease or other major risk factors.”
The IBIS-I results were presented on December 11, 2014 at the San Antonio Breast Cancer Symposium (SABCS 2014) in Texas and published simultaneously in The Lancet Oncology. SABCS is an international scientific symposium for interaction and exchange among basic scientists and clinicians in breast cancer.
It was organized by the Cancer Therapy & Research Center at UT Health Science Center San Antonio, the American Association for Cancer Research, and Baylor College of Medicine. The IBIS-I study, which began recruitment in 1992, enrolled 7,154 pre- and post-menopausal women aged from 35 to 70 years at high risk for breast cancer primarily because of a family history. They were randomly assigned to receive either tamoxifen 20 mg daily for five years (3,579) or placebo (3,575).
Hormone replacement therapy was allowed during the trial and was used by 49.5% in the placebo group, and approximately 35% of women in each group had had a hysterectomy. The median age at enrollment was 50.8 years in each group. At a median of 16 years of follow-up (longest follow-up 22 years), there were 601 breast cancers reported, 251 (7.0%) occurring in women who took tamoxifen, and 351 (9.8%) in women who took placebo.
In subanalysis, the most pronounced reductions in risk were seen for invasive estrogen-receptor-positive (ER+) breast cancer and ductal carcinoma in situ. However, tamoxifen did not significantly reduce the risk for invasive estrogen-receptor-negative (ER-) breast cancer. The extended analysis of the IBIS-I trial was announced a year after the first results of the IBIS-II trial were released, which found taking the breast cancer drug anastrozole (an aromatase inhibitor) for five years reduced the chances of post-menopausal, high-risk women developing the disease by 53% compared with women who took a placebo. Professor Cuzick concludes: “For most post-menopausal women, an aromatase inhibitor such as anastrozole should be the drug of choice, as it is more effective than tamoxifen and has fewer side effects. However… “…for most premenopausal, high-risk women, tamoxifen remains the only drug of choice for breast cancer prevention and it is a good one, as shown by this new evidence.”
Most Filipino patients cannot afford cost of breast cancer screening, treatment
In the Philippines, which has the highest rate of breast cancer in Asia, low awareness may not be the main reason why the majority of breast cancer cases are not diagnosed early. “Most Filipino patients cannot afford the cost of diagnostic tests and treatments for breast cancer,” states the 2010 Philippine Cancer Facts and Estimates, a document published by the Department of Health and Philippine Cancer Society.
Experts recommend that women, starting at the age of 30, perform monthly self breast examination (SBE) and undergo an annual clinical breast examination (CBE) performed by a healthcare professional. Annual mammogram is recommended for women beginning age 40. According to the 2010 Philippine Cancer Facts and Estimates, national breast cancer awareness campaigns which do not include the provision of diagnosis and treatment are outdated and ineffective. It recommended that each province, city, municipality and barangay should establish and implement its own program for breast cancer diagnosis and treatment.
For such a program to succeed and be sustainable, local government officials, insurance providers, NGOs and civic-minded individuals and organizations, health workers and medical specialty societies must work together in providing access to breast cancer screening and treatment.
References:
4. http://www.philhealth.gov.ph/news/2012/z_benefits.html
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Deepak Kumar Bandari,
Pharm.D Intern,
Vaagdevi College of Pharmacy - India
Elsevier Student Ambassador - South Asia
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